Agency: Medicare refills strong drugs despite law

By Kelli Kennedy, Associated Press
September 26, 2012 9:13 p.m.

MIAMI (AP) — Medicare routinely refilled pain pills and other restricted medications that are barred by federal law from renewal without a fresh prescription, government inspectors said in a report Thursday.

The report based on 2009 data found three-quarters of contractors who processed prescriptions for the Medicare Part D program wrongly refilled some medications classed as Schedule II controlled substances, which include strong pain killers and other drugs considered at high risk for abuse. Those refills were worth a total of $25 million.

“Paying for such drugs raises public health concerns and may contribute to the diverting of controlled substances and their being resold on the street,” said the report by the U.S. Department of Health and Human Services inspector general.

The Centers for Medicare and Medicaid Services said in response to the report that the inspector general was misinterpreting partial “fills” dispensed to patients in long-term care facilities as refills. Partial fills occur when a pharmacist does not dispense all doses of the prescribed medication at one time. But the report said there was little evidence of that.

The report said nearly 400,000 Schedule II prescriptions were wrongly refilled, or about 2 percent of all Schedule II prescriptions billed under Medicare Part D in 2009. Of those 400,000, more than 25,000 also lacked some required information, including the name, address or signature of the prescriber.

The report comes as the country wrestles to get a grip on an estimated $60 billion a year in Medicare fraud.

Medicare Part D provides prescription drug coverage for seniors. The federal government contracts with private companies to fill prescriptions and relies on those contractors to have safeguards in place to ensure compliance.

The program forbids providers from issuing refills on controlled substances, yet three-quarters of Medicare Part D contractors paid for refills, according to the report. The prescriptions were mostly filled by long-term care pharmacies.

Two Los Angeles doctors were recently charged with health care fraud after authorities said they prescribed controlled drugs to individuals without a valid medical reason. Medicare paid more than $2.7 million for those drugs over an 18-month period, federal investigators said.

In May, Express Scripts, Inc. paid nearly $3 million to resolve allegations they were using phony prescriber numbers at its mail order pharmaceutical facilities. The company is one of the largest pharmacy benefits managers in the country and runs prescription drug plans for employers, insurers and other customers.

The inspector general recommended that federal health officials automatically flag reimbursement requests from providers for controlled drug refills and refuse to pay them. The report also encouraged the Centers for Medicare and Medicaid Services to work more closely with individual providers on this issue and follow up with those who had a high number of refills.

The agency said it has already provided guidance to contractors regarding partial fills and will consider whether additional direction is necessary. But the agency said working with individual providers and pharmacies is not an efficient use of resources.